Kenneth C. Sawyer

Volvulus of the colon

Abstract A group of fifty-three patients with volvulus of the colon is reported. There were thirty-five adults and eighteen children. This fairly rare cause of intestinal obstruction was more devastating in the latter, accounting for a mortality rate of 44.4 per cent, compared with 5.7 per cent in the adults. The incidence of this lesion is reviewed and the embryology, pathologic process, diagnosis and treatment are discussed.

The unrecognized significance of papillomas, polyps, and adenomas of the gallbladder

Summary Evidence from our clinical experience with twenty-nine cases of papilloma of the gallbladder and from a review of the literature for the past twenty years is adduced in support of the belief that cholecystectomy is the treatment of choice for cholecystitis and cholelithiasis. Illustrative cases, with their roentgenographic findings, gross and microscopic pathologic studies, and follow-up data are presented to emphasize that papillomatous growths in the gallbladder have greater significance than has generally been recognized.

Infectious emphysema of the gastrointestinal tract in the adult

Summary The finding of gas in the viseera outside the lumen of the gastrointestinal tract is rare but is potentially so dangerous that early diagnosis and aggressive treatment are mandatory. Five illustrative cases of pneumatosis of varying causes are presented, with details of their management.

OCCULT CARCINOMA OF THE BREAST

Abstract Three cases of occult carcinoma of the breast are presented. Each case represents a different approach to this problem. In general it is best to biopsy all seemingly abnormal lumps palpable in the axilla, even though statistics suggest that the majority of these will be of nonspecific or benign pathologic origin. We do not believe that a frozen section followed by homolateral radical mastectomy is the proper approach if the lymph nodes are adenocarcinomatous. Instead, the patient should be given further careful examination for a possible primary lesion. This should include x-ray studies as the primary carcinoma may originate in aberrant axillary breast tissue, in an axillary sweat gland or in the respiratory or gastrointestinal tracts. If no primary site is found, the treatment of choice is homolateral radical mastectomy, except in patients who could not tolerate extended surgery or who show evidence of bone metastasis. There will be cases in which a primary site may never be found.

Carcinoma of the thyroid occurring in a diffuse toxic goiter.

Abstract Carcinoma of the thyroid usually is not suspected clinically with diffuse toxic goiter. When the association occurs, the cancer is usually small, often of the papillary type, especially in patients under twenty-five years of age. Often it is discovered only on microscopic examination of the surgical specimen. It has been established that papillary carcinomas of the thyroid are of low grade malignancy and have a prolonged clinical course. This case presented herein occurred in a seventeen year old girl with diffuse toxic hyperplasia of the thyroid in which a small papillary carcinoma was found on microscopic examination of the surgical specimen. We believe the postoperative management of such patients should be conservative and limited to periodic examinations, reserving extensive surgical removal of the regional lymphatics only when recurrence or regional lymph node metastasis becomes clinically manifest.

Fatal primary cancer of the lung in a teen‐age smoker

Fatal primary carcinoma of the lung in a 16‐year‐old boy who smoked cigarettes is described. The disease progressed rapidly even after a lobectomy, without evidence of lymphatic involvement, was performed. A plea is made for even broader education of physicians and laymen in the potential harmful effects of cigarette smoking.

Choriocarcinoma in the male patient presenting as gastrointestinal hemorrhage

Abstract A case of fatal choriocarcinoma in the man is described, and the symptomatology and pathology of this rare condition are discussed.

Intrahepatic cholangiojejunostomy with partial hepatectomy: Report of a successful case

Abstract It is realized that intrahepatic cholangio-jejunostomy is an operative procedure of considerable risk and magnitude. Moreover, as noted in the first four cases mentioned, it may be performed for the purpose of relieving biliary tract obstruction in patients with very distressing symptoms with the additional hope of prolonging their lives. However, as demonstrated by the report of this last patient, an intrahepatic cholangio-jejunostomy may be a life-saving procedure and should have a definite, although limited place, in the armamentarium of every general surgeon.

The pathogenesis of diverticulosis coli

SummaryThe pathogenesis of colonic diverticulosis still is not well understood. It is believed that it is a combination of the degenerative process of aging, associated with spasm and increased intraluminal pressure. There is strong evidence to support the view that a muscle abnormality with shortening and hypertrophy precedes diverticulosis. An associated increase in the frequency and magnitude of spontaneous contractions causes an increase in internal pressure on the colon wall. Ultimately, this results in herniation and pouch formation. Once the diverticulum has herniated through the wall permanently, the continued increased pressure forces fecal contents into the pouch. This also causes vascular engorgement, necrosis of the mucosa, and bacterial penetration.The actual inflammation of diverticulitis results from perforation, rather than stagnation of fecal material. The shortening of the bowel, with spasm and thickening of the circular muscle, results in diverticular disease, and the common “spastic colon” may well be a precursor of diverticulosis coli.

Proliferative cysts of the pancreas.

Abstract Four cases of cystadenoma and one case of cystadenocarcinoma of the pancreas are described. Diagnosis of such pancreatic neoplasms is rare prior to exploratory surgery, although recent advances in x-ray technics, especially angiography, should improve preoperative diagnosis. An aggressive surgical approach is necessary in the treatment of papillary cystadenomas since they are potentially malignant lesions, and early removal of cystadenocarcinomas may allow surgical cure.